How To Align With Common Ground And Shared In A Cloud Computing Environment

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Shared Services/Cloud Computing Ready

for Key Linkages between Federal,

State and Local Communities

John C. Dodd, Fellow

for Health and Human Services and Enterprise Architecture

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Key Message: Alignment with Common Shared Services can

Create Key Design Platforms for Change and Innovation

• Foster alignment between Federal-State-Local Communities is not needed

• Use UCore Concepts, Business Artifact Flows, and Semantic matching along with Adapt with Harmonization with MDMI and Semantic Data

Patterns to define Key universal data elements and shared services that can

be common ground elements

• Defined as Shared Services in a Cloud Computing environment.

• Many Federal, State agencies, and local communities are defining

comprehensive sets of business capabilities and integration. Need Simple

Core and Guidelines

• Some of those business areas e.g., in Medicaid are more outward facing areas like Provider Management, Client Management to be shared within the Cloud.

• The state of trusted shared services, standards and the readiness of cloud computing to address key aspects of an integrated environment.

• What are enablers and barriers to change?

• Is the technology ready? Are we ready? Roadmap to Align and Support

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Key Message: The Healthcare Business Complexity

Provider and Supplier Provider and Supplier Health Plans Health Plans Electronic Health Electronic Health Billing Billing Quality Data Reporting Quality Data Reporting Hospital/ Facility Affiliation Hospital/ Facility Affiliation Imaging Imaging Lab Lab eRx eRx CPOE CPOE Referrals Referrals Billing Service Billing Service Patient Contact And Mgmt Patient Contact And Mgmt Training Training Staffing Staffing COB COB Coordinate Care Coordinate Care Contract Mgmt. Contract Mgmt. Security Security Other Payers Other Payers Employers Employers CMS CMS Insurer Insurer Associations

Associations EducationEducation

Professional Qualification Professional Qualification Certification Certification Research Research Patient Safety Patient Safety Financial Mgmt. Financial Mgmt. Reviews And Audits Reviews And Audits Problem List Problem List Regulation And Compliance Regulation And Compliance Privacy Privacy Liability Liability Treat Prescribe Diagnose Treat Prescribe Diagnose Preventive Care Preventive Care Educating Patients Educating Patients Technology Mgmt. Technology Mgmt. Practice Management Practice Management Attending Attending Payer Mgmt. Payer Mgmt. Workflow Workflow

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Complete Alignment- Business and Services

Framework: Support Alignment Cross Boundaries

To create a coordinated view of health and human services by

linking information and creating meaningful information

exchanges to better support the citizen.

• Common Local Services • Common Local

Business Processes

• Common State Services

• Common State Business Processes • Common State Information Model

• Common Federal

Services

• Common Federal Human

Services Processes

• Common Provider Services • Common Provider

Business Processes COMMON VIEW

LOCAL-COMMUNITY

FEDERAL STATE

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Aligning Shared Services with NIEM/NHIN and

HL7/OMG: Strategic Harmonization and

Transformation Planning

5. Service

Registry: HSSP

S-RAMP

2.

Use Case Prioritized: Business Process

Artifact Flows & Semantic Data

Patterns

4.

UCore by Domain:

Meta Data Management: Data Services: MDMI

3.Automation Support Vocabularies & Ontologies: Semantic Mapping Database Tools: Modeling 1. Strategy-Standards

Segment-Domain Guide: SAIF Plus

Design

Starterkits

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SAIF Value Proposition : Working Interoperability

Interoperability Paradigm (Messages, Documents, Services): specifications

which enable two or more (HL7) trading partners to collaborate in the context

of a specific business interaction

– No assumptions of size, character, or identify of parties

• Nations, Enterprises, Departments, Individual, Systems, etc.

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Common Ground elements Business Architecture:

Service Framework, Common Capabilities, Adaptation,

Extension Approaches

Current State: • Many functions • Many systems

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S y st e m M an ag e m e n t S e rv ic es Shared Services Foundational Services NHIN Shared Services Subject Discovery Messaging

Services Event Log _Services

Info. Exchange

Services

State

Service-Msmt Registry Documents _Services Enrollment Services Lab Services Provider Directory Services Demographic s Services Eligibility Check Immunization Validation Registry Services NHIN Gateway Services Analysis & Reporting Clinical Data Services Claim Services Financial Services EMPI Services HER Interfaces Services Record Locator Services

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SAIF Value Proposition :

Working Interoperability

•

Interoperability: the deterministic exchange of data/information in a manner that preserves shared meaning

• Two “trading partners” interoperate based on a certified “level of shared compliance” to interoperability specifications/standards

• Certified “level of conformance” determine degree of automated interoperability that is possible and/or difficulty of the transformations that are required to enable interoperability

Agree on “Reference” view Agree on “Conceptual” view

Agree on

“Platform-Independent” view Agree on

“Platform -Specific” view A B D C F Component Component E A -- F: trading partners

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Many Aspects of Quality Measurement, Payment Reform, and

Health IT Must Work Together to Improve Care

2010 2011 2012 2013 2014

Increasingly sophisticated, patient-centered information about quality, costs, and

care experience Measure ment an d Data C ollectio n Meaning ful Use o f Health IT Availab ility of E lectroni c Clinic al Healt h IT Sys tems Paymen t Reform s/Incen tives Health I T and In teropera bility St andards

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Systemic Reform:

Innovation Prescription

General Hospital Isolated Best Practices Systemic Reform Physician Practices Business Model Innovation Your Transform Plan-Aligned…. Affordable Care Act (2010) To-Be “new” Health Business Models Intuitive Medicine: Empirical Medicine: Precision Medicine:

Outside and Inside Innovation: Focused Models

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Working to improve health and human services to citizens through an information-driven enterprise

Local/State/Federal/Private Information Exchanges

Provide the

Foundation

to Support Business Priorities

Improving Services to Children Enrollment and Coordination of Benefits Population Health Reporting

Business and Services Framework Federal Health Information Model

Business Process Improvement Areas

SNAP Scho ols SAC WIS Social Workers Family Co urts Sub stan ce Ab use Tr eatmen t Centers Head Start Local Child Welfare Ju ven ile Co urts Newborn Metabolic Screening Newborn Hearing Screening IRS SSA Immun ization Reg istry Labs Child Support Enforcement CHIP State Dep artmen t of Vital Statistics TANF WIC School Breakfast Program Medicaid Foster Care Child Care School Lunch Program Health car e Provider s

Alignment can link Health & Human Services

• Common Local Services • Common Local

Business Processes

• Common State Services • Common State Business Processes • Common State Information Model

• Common Federal

Services

• Common Federal Human

Services Processes

• Common Provider Services • Common Provider

Business Processes COMMON VIEW

LOCAL-COMMUNITY

FEDERAL STATE

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Moving the Needle within 30 months: Agile Architecture

and Rapid Development

Improved Quality & Efficiency Provider Feedback & Measurement

Care

Delivery

System

Payment Reform

HIT Foundation:

Meaningful Use of EHR & HIE’s

Communities- Grants and Pilots….Looking for

Innovations aligned to Goals

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Key aspects of an integrated environment:

Capabilities

with Coordinated Views of each Business Challenge with a

360 Citizen-Client-Caseworker at the Center

Local-Community

View

State

View

Federal

View

Citizen

View

Business

Challenges

Provider

View

Citizen-Client & Family Common View

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“Strawman” Health and Human Services Business Capability

Categories: Human Services

Health and Human Services Business Service

Common Ground Business Services

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Business Areas

Alignment defining Cross Boundary Business Operations Models: Finding Common Ground Process

State &

Local

Communities:

•State Architecture •NASCIO •MITA Self Assessment & •HHS Business Architecture

Common

Ground:

Common State HHS Aligned with Fed

NIEM NHIN MITA FHA Transform CONNECT

Federal:

•FEA •HHS EA •NIEM •NHIN •MITA •FHA •Transform •CONNECT

2. Business Process Artifacts-Entity-Access

Policies and Process Alignment

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Starter Kit: Support the Range of Organizations with a Family of Services

Shared Services Light

Big Org Change

Linking Key Shared Services

HIE Node in

Cloud

Health

Enterprise Transformation:

Tailored EA-SOA COTS partners

Small Org Changes Assurance: Service Factory

IdM-Security- Consent-Compliance Services Enterprise Transformation for Health Care Reform: From

Fragmented to Loosely Coupled

Shared Services in Cloud

Provider

Mgmt

Data

Mgmt

Msmt

Mgmt

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“Strawman” Health and Human Services Business

Capability Categories: Human Services

Health and Human Services Business Service

Feds lead

Alignment with

Stakeholders

Series of Capability

Templates Created

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Enablers and Barriers

Enablers

• It makes sense….

• The technology-standards are there- (privacy still being worked but much better than last year)

• NIEM/NHIN converging and many other related standards

• Many excellent examples of small to medium interoperability…

• Some models for Cancer Research, Public Health…..

• Lots of financial transactions….

Barriers

• But means you have to talk across boundaries…

fragmentation is strong

• Not well known and “Health” has often been isolated from the

many other interoperability- “we are different”….

• Distribution of knowledge- some real leaders but huge

“gap”-“Crossing the Chasm” and becoming mainstream

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Is the technology ready? Are we ready?

• Good libraries of basic services and push for more open source for

health issues…….adapters that can be shared

• Interoperability- HL7 and OMG others working together

• Office of National Coordinator – “don’t need to solve everything

attitude”…and phased approach…..NIEM/NHIN and Health

Interoperability Model

• Business Architecture and tie in Performance

Architecture-Dashboards

• Business Artifacts/ BEDL……..IBM and others

• SOA- SOAML, Model Driven Message Interoperability (MDMI)

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Trusted Cloud Services…

… will require orchestration, integration, monitoring, SLA

management, security, monitoring, master data management,

auditing, metering, billing, and so much more

Security _Provisioning Administration Billing Monitoring Disaster Recovery SLA Management Integration Identity Authorization Master Data Management Auditing Service-Oriented Architecture (SOA)

CSC Enterprise Cloud Services Management (Orchestration)

Transaction Logging Federation Single Sign-On Fault Tolerance Policy-Based Access Mgmt. ITIL Compliance Directory Services Policy Administration Software as a Service Platform as a Service Infrastructure as a Service Business Process as a Service Cloud Computing Partnership

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Cloud Computing Partnership

Power of Choice: Software + Services

SERVICES

Many

Choices:

Some

Standards

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CSC TRUSTED CLOUD VISION

Information Assurance is Cloud-Complicated,

_{“Clouds are cloudy”}

As visibility is lost …

• Where is the data?

• Who can see the data?

• Who has seen the data?

• Is data untampered?

• Where is processing performed?

• How is processing configured?

• Does backup happen? How? Where?

Requirements

Services

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A “TRUSTED” CLOUD

Services rendered via a Trusted Cloud are

“Trusted Cloud Services”

The generation of new enterprise value with Trusted Cloud Services is

an application of Digital Trust harmonizes the security for transactions and data with… comprehensive transparency of control and result such that…

A Cloud That…

conveys evidence-based confidence that systems within its environment operate as advertised, and that no unadvertised functions are occurring…

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ORCHESTRATION CORE

Translation of Business Needs to Trusted Cloud

Service Delivery

. . .

Trusted Cloud

1. Trusted Cloud Service decision support

• Trusted cloud services business needs

analysis and recommendations (CloudAssist)

2. Orchestrator of Orchestrators

• The automated arrangement, coordination, connection, and accountability for individual cloud service contributions

CloudTrust Protocol

Business and technical needs integration knowledge

Private Cloud

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Information Centric Security Solutions

Databases

Applications

DATABASE SECURITY Encryption and Data Masking Access Control and

Authorization Activity Monitoring IDENTITY AND ACCESS MANAGEMENT Identity

Administration Directory Services

Access Management INFORMATION RIGHTS MANAGEMENT Centralized Document Access Control Revocation (Digital Shredding) Document Activity Monitoring and Audit

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Defining a “Transparency-Msmt” Shared Services Cloud

Technology Roadmap: Boundaries and Policies for Sharing

HIE in Cloud

Registry-Data Collection-Msmt In Cloud Consumer Information-Insurance Exchange in Cloud Comparative Data-Effectiveness in Cloud OR & Performance Improvement Tools in Cloud

“Partner-Policy

Hybrid” Profiles

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Defining a “Common Ground” Shared Services Cloud

Technology Roadmap: Boundaries and Policies for Sharing

HIE with Service Registry in Cloud Provide Management Registry- Support In Cloud Consumer-Client Benefit Recommender Enroller- Tracking in Cloud

Care and Service Management in Cloud Decision Options For Consumer in Cloud “Partner-Policy Hybrid” Profiles

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Standards and Open Services: Strategic Roadmaps to Citizen-Population Group Coordinated Services and Integrated Across

Views: Addressing Aligned Concerns

• Leveraging • Focused Concerns Foster Integrated Pilots and Demo Experience Review Many pilots: Look for

Integrated Results

Legislative

Reform

Vision

Gather Concerns: Continuing to Engage Community- Filling Gaps Paym ent C hang es: M ega Outco mes

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Target

Vision:

Open

Innovation

Roadmap

Adop ting EHR’ s and “Mea ningf ul Us e” Ch ange s Info rmat ion C omm onali ty an d Qu ality Impr ovem ent Popu lation Foc used and Pra ctice Cha nges HSSP Align with “Current” Fed Health

Strategy & FHA

Engage

State-Local-Provider Communities

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